Refugees arriving in Canada are faced with many challenges, including: •
Language
Climate
Cultural differences: food, parenting, family dynamics, visiting, eating, courtesies
Employment/education
Health/Mental health
Lack of support
Isolation
Financial situation
Conflight with personal expectations of what life in Canada is going to be like
The challenges refugees encounter and the physical or psychological effects of adjustment to life in Canada also partly depend on the reason for emigration (war, natural disaster, religious or political persecution, economic hardship).
Phases of Refugee Transition
After a refugee decides to leave their homeland, the timeline has been divided by scholars into five stages. These are seen in Table 1.
In the impact/preparatory stage (when the crisis occurs), family & local community members come together, consolidating resources & developing a plan.
The overcompensation stage occurs on arrival in the new country, where the refugee's energies are mobilized to enable them to live in a strange country.
After the "honeymoon period," refugees often have a decompensation stage as the challenges of life in a new environment become apparent.
Refugees may then go through a phase of intergenerational and cultural conflict.
Sluzki CE. Migration and family conflict. Fam Process 1979;18:379-90.
Refugees are screened for diseases before arrival to Canada with the Immigration Medical Exam.
This consists of:
Full physical examination for all family members;
PA chest X–ray and a radiologist's report for any person aged 11 or over
Blood test (VDRL or similar test) for everyone aged 15 or over
Urinalysis (sugar, protein, and blood) for all applicants aged 5 or over.
HIV testing
While this is a helpful first step, we know that refugees face poorer health outcomes and many health problems. These include:
Dental problems
Hepatitis B
Gastrointestinal parasites
Tuberculosis
Hepatitis C
Post-traumatic stress disorder
Anemia - iron deficiency, thalassemia, other hemoglobinopathies, infection with hookworm, malaria
Rheumatic heart disease
Anxiety or depression
An estimated 2/3 of reguees experience some form of this after arrival to the US
Blindness - cataracts, diabetic retinopathy, infectious causes of blindness, trauma
Unwanted pregnancy
Refugees also have been found to have impaired accessibility to preventive screening services. This is particularly seen in the low rates of immigrant women who undergo cervical cancer screening with Pap smears.
For more information on health problems encountered by refugees, as well as recommended screening, see:
Canadian Guidelines for Immigrant Health - Summary of clinical preventive care recommendations for newly arriving immigrants and refugees to Canada: http://www.cmaj.ca/cgi/rapidpdf/cmaj.090313v1
Challenges faced by Government-Assisted Refugees
Refugees arriving in Canada are faced with many challenges, including:
•
The challenges refugees encounter and the physical or psychological effects of adjustment to life in Canada also partly depend on the reason for emigration (war, natural disaster, religious or political persecution, economic hardship).
Phases of Refugee Transition
After a refugee decides to leave their homeland, the timeline has been divided by scholars into five stages. These are seen in Table 1.
In the impact/preparatory stage (when the crisis occurs), family & local community members come together, consolidating resources & developing a plan.
The overcompensation stage occurs on arrival in the new country, where the refugee's energies are mobilized to enable them to live in a strange country.
After the "honeymoon period," refugees often have a decompensation stage as the challenges of life in a new environment become apparent.
Refugees may then go through a phase of intergenerational and cultural conflict.
Sluzki CE. Migration and family conflict. Fam Process 1979;18:379-90.
Refugees are screened for diseases before arrival to Canada with the Immigration Medical Exam.
This consists of:
While this is a helpful first step, we know that refugees face poorer health outcomes and many health problems.
These include:
Refugees also have been found to have impaired accessibility to preventive screening services. This is particularly seen in the low rates of immigrant women who undergo cervical cancer screening with Pap smears.
For more information on health problems encountered by refugees, as well as recommended screening, see:
Canadian Guidelines for Immigrant Health - Summary of clinical preventive care recommendations for newly arriving immigrants and refugees to Canada:
http://www.cmaj.ca/cgi/rapidpdf/cmaj.090313v1
Clinical Primer for Immigrant & Refugee Health:
Medical Care for Immigrants and Refugees: http://www.aafp.org/afp/980301ap/gavagan.html